Search Results (559)

During the coronavirus 2019 pandemic, sports activities were restricted, raising concerns about their impact on the physical condition of adolescent athletes, which remained largely unquantified. This study was designed with two primary objectives: first, to precisely quantify and elucidate the differences in the physical condition of adolescent athletes before and after activity restrictions due to the pandemic; and second, to innovatively develop and validate a non-contact medical checkup application. Medical checks were conducted on 563 athletes designated for sports enhancement. Participants were junior high school students aged 13 to 15, and the sample consisted of 315 boys and 248 girls. Furthermore, we developed a smartphone application and compared self-checks using the application with in-person checks by orthopedic surgeons to determine the challenges associated with self-checks. Statistical tests were conducted to determine whether there were statistically significant differences in range of motion and flexibility parameters before and after the pandemic. Additionally, items with discrepancies between values self-entered by athletes using the smartphone application and values measured by specialists were detected, and application updates were performed. Student’s t-test was used for continuous variables, whereas the chi-square test was used for other variables. Following the coronavirus 2019 pandemic, athletes were stiffer than during the pre-pandemic period in terms of hip and shoulder joint rotation range of motion and heel–buttock distance. The dominant hip external rotation decreased from 53.8° to 46.8° (p = 0.0062); the non-dominant hip external rotation decreased from 53.5° to 48.0° (p = 0.0252); the dominant shoulder internal rotation decreased from 62.5° to 54.7° (p = 0.0042); external rotation decreased from 97.6° to 93.5° (p = 0.0282), and the heel–buttock distance increased from 4.0 cm to 10.4 cm (p < 0.0001). The heel–buttock distance and straight leg raising angle measurements differed between the self-check and face-to-face check. Although there are items that cannot be accurately evaluated by self-check, physical condition can be improved with less contact by first conducting a face-to-face evaluation under appropriate guidance and then conducting a self-check. These findings successfully address our primary objectives. Specifically, we demonstrated a significant decline in the physical condition of adolescent athletes following pandemic-related activity restrictions, thereby quantifying their impact. Furthermore, our developed non-contact medical checkup application proved to be a viable tool for monitoring physical condition with reduced contact, although careful consideration of measurable parameters is crucial. This study provides critical insights into the long-term effects of activity restrictions on young athletes and offers a practical solution for health monitoring during infectious disease outbreaks, highlighting the potential for hybrid checkup approaches. Full article

Adhesive capsulitis is a painful and progressive condition marked by significant limitations in shoulder mobility, particularly affecting external rotation. Although magnetic resonance imaging is regarded as the reference standard for assessing intra-articular structures, its high cost and limited availability present challenges in routine clinical use. In contrast, musculoskeletal ultrasound has emerged as an accessible, real-time, and cost-effective imaging modality for both the diagnosis and treatment guidance of adhesive capsulitis. This narrative review compiles and illustrates current evidence regarding the role of ultrasound, encompassing static B-mode imaging, dynamic motion analysis, contrast-enhanced techniques, and sonoelastography. Key sonographic features—such as thickening of the coracohumeral ligament, fibrosis in the axillary recess, and abnormal tendon kinematics—have been consistently associated with adhesive capsulitis and demonstrate favorable diagnostic performance. Advanced methods like contrast-enhanced ultrasound and elastography provide additional functional insights (enabling evaluation of capsular stiffness and vascular changes) which may aid in disease staging and prediction of treatment response. Despite these advantages, the clinical utility of ultrasound remains subject to operator expertise and technical variability. Limited visualization of intra-articular structures and the absence of standardized scanning protocols continue to pose challenges. Nevertheless, ongoing advances in its technology and utility standardization hold promise for the broader application of ultrasound in clinical practice. With continued research and validation, ultrasound is positioned to play an increasingly central role in the comprehensive assessment and management of adhesive capsulitis. Full article

This study aimed to compare isometric strength, range of motion (RoM), and strength ratios of shoulder internal and external rotators between female volleyball and hand ball players Twenty-five volleyball players (age = 21.8 ± 4.8 years, height = 178.5 ± 7.1 cm, mass = 69.3 ± 7.7 kg) and twenty-four handball players (age = 19.5 ± 2.9 years, height = 169.7 ± 6.4 cm, mass = 67.6 ± 8.4 kg), all competing in the Slovenian 1st national league, participated. Maximal isometric strength and passive RoM of internal and external rotation were measured bilaterally using a handheld dynamometer and goniometer, respectively. A significant group × side interaction was observed for internal rotation RoM (F = 5.41; p = 0.024; η² = 0.10), with volleyball players showing lower RoM on the dominant side (p = 0.001; d = 0.89), but this was not the case for handball players (p = 0.304). External rotation strength also showed a significant interaction (F = 9.34; p = 0.004; η² = 0.17); volleyball players were stronger in the non-dominant arm (p = 0.033), while handball players were stronger in the dominant arm (p = 0.041). The external-to-internal rotation strength ratio was significantly lower on the dominant side in volleyball players compared to handball players (p = 0.047; d = 0.59). Findings suggest sport-specific adaptations and asymmetries in shoulder function, emphasizing the need for sport-specific and individually tailored injury prevention strategies. Volleyball players, in particular, may benefit from targeted strengthening of external rotators and flexibility training to address imbalances. Full article

Accurate estimation of upper-limb joint angles is essential in biomechanics, rehabilitation, and wearable robotics. While inertial measurement units (IMUs) offer portability and flexibility, systems requiring multiple inertial sensors can be intrusive and complex to deploy. In contrast, optical motion capture (MoCap) systems provide precise tracking but are constrained to controlled laboratory environments. This study presents a deep learning-based approach for estimating shoulder and elbow joint angles using only three IMU sensors positioned on the chest and both wrists, validated against reference angles obtained from a MoCap system. The input data includes Euler angles, accelerometer, and gyroscope data, synchronized and segmented into sliding windows. Two recurrent neural network architectures, Convolutional Neural Network with Long-short Term Memory (CNN-LSTM) and Bidirectional LSTM (BLSTM), were trained and evaluated using identical conditions. The CNN component enabled the LSTM to extract spatial features that enhance sequential pattern learning, improving angle reconstruction. Both models achieved accurate estimation performance: CNN-LSTM yielded lower Mean Absolute Error (MAE) in smooth trajectories, while BLSTM provided smoother predictions but underestimated some peak movements, especially in the primary axes of rotation. These findings support the development of scalable, deep learning-based wearable systems and contribute to future applications in clinical assessment, sports performance analysis, and human motion research. Full article

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy. Full article

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article

Objectives: Shoulder injury prevalence appears to be the highest among all injuries in CrossFit (CF) athletes. Nevertheless, there is no evidence deriving from prospective studies to explain this phenomenon. The purpose of this study was to document shoulder injury incidence in CF participants over a 12-month period and prospectively investigate the risk factors associated with their demographic, epidemiological, and functional characteristics. Methods: The sample comprised 109 CF athletes in various levels. Participants’ data were collected during the baseline assessment, using a specially designed questionnaire, as well as active range of motion, muscle strength, muscle endurance, and sport-specific tests. Non-parametric statistical tests and inferential statistics were employed, and in addition, linear and regression models were created. Logistic regression models incorporating the study’s continuous predictors to classify injury occurrence in CF athletes were developed and evaluated using the Area Under the ROC Curve (AUC) as the performance metric. Results: A shoulder injury incidence rate of 0.79 per 1000 training hours was recorded. Olympic weightlifting (45%) and gymnastics (35%) exercises were associated with shoulder injury occurrence. The most frequent injury concerned rotator cuff tendons (45%), including lesions and tendinopathies, exhibiting various severity levels. None of the examined variables individually showed a statistically significant correlation with shoulder injuries. Conclusions: This is the first study that has investigated prospectively shoulder injuries in CrossFit, creating a realistic profile of these athletes. Despite the broad spectrum of collected data, the traditional statistical approach failed to identify shoulder injury predictors. This indicates the necessity to explore this topic using more sophisticated techniques, such as advanced machine learning approaches. Full article

In an era defined by rapid technological advancements, the intersection of artificial intelligence and industrial innovation has garnered significant attention from both academic and industry stakeholders. The emergence of Industry 4.0, characterized by the integration of cyber–physical systems, the Internet of Things, and smart manufacturing, demands the evolution of operational methodologies to ensure processes’ sustainability. One area of focus is the development of wearable systems that utilize artificial intelligence for the estimation of arm movements, which can enhance the ergonomics and efficiency of labor-intensive tasks. This study proposes a Random Forest-based regression model to estimate upper arm kinematics using only shoulder orientation data, reducing the need for multiple sensors and thereby lowering hardware complexity and energy demands. The model was trained on biomechanical data collected via a minimal three-IMU wearable configuration and demonstrated high predictive performance across all motion axes, achieving R² > 0.99 and low RMSE scores on training (1.14, 0.71, and 0.73), test (3.37, 1.97, and 2.04), and unseen datasets (2.77, 0.78, and 0.63). Statistical analysis confirmed strong biomechanical coupling between shoulder and upper arm motion, justifying the feasibility of a simplified sensor approach. The findings highlight the relevance of our method for sustainable wearable technology design and its potential applications in rehabilitation robotics, industrial exoskeletons, and human–robot collaboration systems. Full article

Background/Objectives: Dyskinetic cerebral palsy (DCP) often implies severe motor impairment and risk of health problems. Our aim was to follow up a group of young adults with DCP that we previously examined as children, to describe health, function, and living conditions. Methods: Interviews regarding health issues, treatments, and living conditions, and quality of life (RAND-36) and fatigue questionnaires were completed. Gross and fine motor function, communication, and speech ability were classified, and weight, height, spasticity, and dystonia were assessed and compared to previous data. Joint range of motion (ROM) was compared to older adults with DCP. Results: Dystonia was present in all fifteen participants, and spasticity in all but two. A decrease was found mainly in those who received intrathecal baclofen (ITB). ROM limitations were most pronounced in shoulder flexion, abduction and inward rotation (while outward rotation was hypermobile), hip abduction, hamstrings, and knee extension. The majority had frequent contact with primary and specialist healthcare. Seven participants were underweight, eight had a gastrostomy, and seven had ITB. Upper gastrointestinal and respiratory problems were frequent. Orthopedic surgery for scoliosis was reported in five, and lower extremity in nine, while fractures were reported in six participants. RAND-36 revealed physical functioning, general health, and vitality as the greatest problem areas. Fatigue was significant in 64%. Eight participants lived with their parents. Participants at more functional levels completed tertiary education and lived independently. Conclusions: Most participants had severe impairment and many health issues, despite decreased dystonia and spasticity due to ITB. Sleep problems and pain were uncommon. Full article

Accurate range of motion (ROM) assessment is essential for evaluating musculoskeletal function and guiding rehabilitation, particularly in pediatric populations. Traditional methods, such as optical motion capture and handheld goniometry, are often limited by cost, accessibility, and inter-rater variability. This study evaluated the feasibility and accuracy of the Microsoft Azure Kinect-powered Monitored Augmented Rehabilitation System (MARS) compared to Kinovea. Sixty-five pediatric participants (ages 5–18) performed standardized shoulder and elbow movements in the frontal and sagittal planes. ROM data were recorded using MARS and compared to Kinovea. Measurement reliability was evaluated using intraclass correlation coefficients (ICC3k), and accuracy was evaluated using root mean squared error (RMSE) analysis. MARS demonstrated excellent reliability with an average ICC3k of 0.993 and met the predefined accuracy threshold (RMSE ≤ 8°) for most movements, with the exception of sagittal elbow flexion. These findings suggest that MARS is a reliable, accurate, and cost-effective alternative for clinical ROM assessment, offering a markerless solution that enhances measurement precision and accessibility in pediatric rehabilitation. Future studies should enhance accuracy in sagittal plane movements and further validate MARS against gold-standard systems. Full article

Background: Scapular body fractures, when significantly displaced or malunited, can cause glenohumeral discomfort and functional disability. This study compares single- and dual-plating techniques in terms of pain, function, and active range of motion (aROM) in patients with scapular body fractures. Methods: Twenty-eight patients with scapular fractures were retrospectively analyzed, with sixteen undergoing single plating treatment and twelve dual plating treatment. The mean age was 44.9 years, and the mean follow-up was 14 months for single plating and 13.8 months for dual plating. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores, the Visual Analog Scale (VAS) for pain, aROM measurements, and the time to return to work. Functional outcomes were assessed using two-way ANOVA with Šidák’s multiple comparisons test at 2 weeks, 4 weeks, 3 months, 6 months, and 1 year. The time to return to work was analyzed with survival analysis and a log-rank test. Results: The single plating group had higher DASH scores than the dual plating group at 2 weeks (44.88 ± 10.81 vs. 32.75 ± 6.05, p = 0.005), 4 weeks (28.50 ± 5.91 vs. 22.83 ± 4.24, p = 0.033), and 3 months (19.63 ± 2.45 vs. 16.00 ± 2.45, p = 0.004), indicating greater disability. VAS scores were also higher in the single plating group at 2 weeks (4.00 ± 1.21 vs. 2.33 ± 0.88, p = 0.002) and 4 weeks (2.50 ± 1.03 vs. 1.17 ± 0.94, p = 0.008), suggesting faster pain relief in the dual plating group. However, differences were no longer significant after 3 months. At 1 year, the dual plating group demonstrated better external rotation (73 ± 3° vs. 63 ± 5°, p = 0.032), with no significant differences in internal rotation, abduction, or forward flexion. Dual plating patients returned to work earlier (Hazard Ratio = 3.346, 95% CI: 1.208 to 9.269, p = 0.020). Conclusions: In the current cohort, dual plating for scapular fractures offers superior early pain relief and functional outcomes compared to single plating, along with better external rotation at 1 year and an earlier return to work. These findings suggest that dual plating may facilitate faster recovery and enhanced active range of motion in selected patients, a hypothesis that warrants further investigation through future randomized trials. Full article

Background/Objectives: Overhead athletes, including swimmers, are prone to shoulder adaptations and pathologies, such as scapular dyskinesis (SD) and glenohumeral internal rotation deficit (GIRD). While SD has been extensively studied in various overhead sports, its prevalence and clinical implications in swimmers remain unclear. This study aims to evaluate static scapular asymmetries (SAs), defined as differences in the observed position of the scapulae at rest or in a fixed position, in young elite swimmers and compare these findings with functional scapular dyskinesis (SD) tests, which assess alterations in scapular motion patterns during arm movement. It also assesses potential relationships between SA and SD. Methods: A cohort of 661 young elite swimmers (344 males, 317 females) was assessed during the National Young Swimming Championships. Scapular asymmetries were measured in two positions: at rest and at 90° abduction with internal rotation. The measurements included the following: (1) dHeight: Difference in superomedial scapular angle height from the C7 spinal process; (2) dDistance: Difference in the distance of the superomedial scapular angle from the body midline; (3) dAngle: Angular deviation of the medial scapular border from the plumb line, assessed using a goniometer. The presence of scapular dyskinesis (SD) was determined using a functional test, and SA findings were compared with SD results. Statistical analyses included ANOVA and chi-square tests, with significance set at p < 0.05. Results: Scapular asymmetries were observed in 3.63% to 15.43% of swimmers, with no significant associations with age, gender, BMI, training years, or swimming characteristics (p > 0.05). A significant difference was observed between dominant limb and scapular height in abduction (p < 0.05). In position 1 (resting position), SA was significantly more prevalent in swimmers without SD (p < 0.001 for dHeight, p = 0.016 for dDistance). In position 2 (abduction), SA was significantly associated with SD-negative subjects in dAngle (p = 0.014) and dDistance (p = 0.02), while dHeight was not significant (p > 0.05). These findings suggest that static scapular asymmetries do not necessarily correlate with dynamic scapular dysfunction (SD), and, indeed, a negative correlation was observed where SA was significantly more prevalent in swimmers without SD in several measures (position 1, p < 0.001 for dHeight and p = 0.016 for dDistance; position 2, p = 0.014 for dAngle and p = 0.02 for dDistance). Conclusions: Young elite swimmers exhibit a relatively symmetrical scapular positioning, with scapular asymmetries potentially representing normal adaptations rather than pathological findings. The lack of positive correlation between SA and SD, and the higher prevalence of SA in SD-negative subjects, suggests the need for caution when interpreting static scapular assessments in swimmers as SA may reflect sport-specific adaptations rather than pathology. Full article

Background/Objectives: Scapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Methods: Eighteen adult volunteers with chronic shoulder pain participated in an 8-week scapular therapeutic exercise program that was personalized according to their pain condition and the presence of scapular dyskinesis. This program included preparation and warm-up, scapular neuromotor control, and strengthening and stretching exercises. Both self-reported (shoulder pain and function, psychosocial factors, and self-impression of change) and performance-based outcomes (scapular muscular stiffness and activity level, tridimensional motion, rhythm, and movement quality, measured while participants drank a bottle of water) were used for analysis. Results: After the intervention, participants presented reduced shoulder pain (p < 0.0001) and pain catastrophizing (p = 0.004) and increased shoulder function (p < 0.0001). Additionally, the participants presented changes in scapular winging (p < 0.0001 to p = 0.043), increased scapular downward rotation (p < 0.0001) and depression (p = 0.038), and decreased global movement smoothness (p = 0.003). These were associated with changes in serratus anterior activity (p = 0.016 to p = 0.035), decreased middle (p < 0.0001 to p = 0.002) and lower trapezius (p < 0.0001) and levator scapulae (p = 0.048) activity levels, and decreased middle trapezius muscle stiffness (p = 0.014). Patients’ self-perception of change was rated favorably. Conclusions: After a scapular therapeutic exercise program, changes were observed in both self-reported and performance-based outcomes. These results need to be confirmed by a randomized controlled trial. Full article